Abstract
Objectives:
The minimum clinically important difference (MCID) is a commonly used measure to aid in determining significant improvements for patient-reported outcomes (PROs). As MCID and PROs continue to be implemented in shoulder procedures, MCID can greatly differ depending upon the specific patient population, follow-up time, and methodology. In the setting of rotator cuff repair (RCR), there are few studies that discuss the effect of tendon involvement on MCID achievement. Additionally, there is a paucity of literature surrounding the use of the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) as an anchor question. The purpose of this study was to evaluate the effect of the number of tendons involved in the RCR on MCID achievement. They hypothesis was that larger repairs would be associated with a lower likelihood of meeting MCID. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included retear and reoperation rates.
Methods:
The minimum clinically important difference (MCID) is a commonly used measure to aid in determining significant improvements for patient-reported outcomes (PROs). As MCID and PROs continue to be implemented in shoulder procedures, MCID can greatly differ depending upon the specific patient population, follow-up time, and methodology. In the setting of rotator cuff repair (RCR), there are few studies that discuss the effect of tendon involvement on MCID achievement. Additionally, there is a paucity of literature surrounding the use of the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) as an anchor question. The purpose of this study was to evaluate the effect of the number of tendons involved in the RCR on MCID achievement. They hypothesis was that larger repairs would be associated with a lower likelihood of meeting MCID. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included retear and reoperation rates.
Results:
A total of 799 patients met inclusion criteria. Most patients were male (n=474, 59.3%) and were 61.2 years old. There were 61.5% of patients who had their dominant shoulder treated with RCR. Patients typically had two tendons repaired (n=369, 46.2%) at least one tendon with a full thickness tear (n=643, 80.5%). Many underwent various concomitant procedures including subacromial decompression (83.9%), biceps tendon procedures (tenotomy or tenodesis) (59.0%), distal clavicle excision (24.2%), and arthroscopic debridement (24.0%). The average case length was 130.1 minutes. There were 36 symptomatic retears (4.5%), 10 revisions (1.3%), and 14 other reoperations (1.8%) within one-year. ASES scores at baseline and one-year were 48.1 and 84.6, respectively, with an average one-year change of +36.6. The one-year ASES MCID was calculated to be 37.9. A total of 52.1% of patients achieved the one-year MCID. A higher proportion of females compared to males (58.2% vs. 47.9%, p=0.004) met MCID. Age and BMI were not associated with MCID achievement (p=0.955, p=0.393, respectively). Patients who were treated for worker’s compensation were less likely to achieve MCID (Worker’s comp that met MCID: 35.9% vs not meeting MCID 64.2%, p=0.014).
The number of tendons repaired did not differ between those who met MCID and those who did not (p=0.315). Thickness of the tear and operation on the dominant arm also had no effect on MCID achievement (p=0.837, p=0.915, respectively). Biceps tenotomy was shown to have more patients who met MCID compared to biceps tenodesis (63.0% vs. 48.3%, p=0.032). Those who underwent subacromial decompression more often met MCID than those who did not (p=0.002). Experiencing retear and reoperation were associated with not meeting MCID (p<0.001, p=0.004, respectively) while revision trended towards significance (p=0.055).
Conclusions:
The average ASES score reported was 84.6, and 52.1% of patients met the one-year MCID. Female sex, biceps tenotomy and subacromial decompression were all associated with achieving MCID, while worker’s compensation, retear, and reoperation were more prevalent in patients who did not meet MCID. The number of tenons involved was shown to have no effect on MCID attainment. This information can help surgeons address patient expectations prior to undergoing RCR surgery.
